Management of Toe Injuries

Initial Assessment

The American College of Radiology recommends evaluating for signs of fracture including localized tenderness, swelling, and pain with weight-bearing 1
The American Diabetes Association suggests assessing skin integrity and musculoskeletal deformities in a well-lit room, and examining for any open wounds or signs of infection, as well as checking neurovascular status including sensation and circulation to the toe 2

The American College of Radiology states that plain radiographs are the mainstay of initial imaging for suspected toe fractures, and a three-view radiographic study (anteroposterior, oblique, and lateral) is typically recommended 1
The American College of Radiology also notes that CT is not routinely used as the first imaging study for toe injuries, and MRI is not routinely indicated for initial evaluation of toe injuries 1
Ultrasound has shown less successful results compared to radiographic evaluation, with 90.9% sensitivity and specificity for detecting fractures, according to the American College of Radiology 1

For patients with minor injuries, the American Diabetes Association recommends using well-fitted walking shoes or athletic shoes that cushion the feet and redistribute pressure, and for bony deformities, extra wide or deep shoes may be needed 2
Custom-molded shoes may be required for extreme bony deformities that cannot be accommodated with appropriate footwear, as suggested by the American Diabetes Association 2

The American Diabetes Association notes that for patients with diabetes, a stubbed toe requires more careful monitoring due to increased risk of complications, and patients with peripheral neuropathy, foot deformities, or peripheral vascular disease need more thorough evaluation after toe injury 2
Patients with visual difficulties, physical constraints, or cognitive problems may need assistance with proper foot monitoring and care, according to the American Diabetes Association 2

The American College of Radiology recommends monitoring for signs of healing including decreased pain and swelling, and if pain persists beyond 7-10 days or worsens, consider follow-up imaging to rule out occult fracture 1

The American College of Radiology warns that failing to obtain radiographs when a fracture is suspected can lead to improper healing and chronic pain, and overlooking associated injuries to adjacent toes or metatarsals 1